Squatting after Unicondylar Knee Replacement

Knee Replacement is a revolutionary surgery. It gives patients a miraculous cure from severe knee pain and deformity. Patients achieve a lasting and complete relief from pain. It is a boon for patients handicapped by knee arthritis. It is one of the most successful surgeries in all of medicine.
In an effort to continuously improve, science makes breakthroughs all the time. The knee is made of 3 compartments. Arthritis damages these compartments but often not uniformly.  When we as surgeons are doing total knee replacement, we often find that one compartment is badly damaged whereas the other compartments are well preserved. In total knee replacement, we replace all the compartments irrespective of the damage. The knee also has two important ligaments called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments are removed in a total knee replacement. Replacing all compartments leads to much bone loss and bleeding. In order to do a good knee replacement, we need to take a big incision (cut) in the skin and the muscle. Big cuts result in more pain and slower recovery. Patients need supervised physiotherapy to regain knee function. After total knee replacement patients can walk freely and comfortably, however the absence of ligaments doesn't allow them to sit on the floor or squat easily.
Scientific research has led to the evolution of Unicondylar Knee Replacement (UKA) to solve these issues. The principle of UKA is to replace only the damaged compartment. Only one of the three knee compartments is replaced. There is minimum cutting of bone and less blood loss. Patients feel much less pain and recover quickly. No painful physiotherapy is required after surgery. My UKA patients are walking comfortably just a few hours after surgery. They hardly feel postoperative pain. The surgery is done through a small cut in the skin using special instruments with a minimally invasive technique. Both ACL and PCL are preserved. After UKA patients are able to easily squat in a toilet and sit on the floor. UKA feels like a natural knee. The long term results of UKA are comparable to total knee replacement. UKA is just as durable and will give a patient many years of pain-free knees.
Not all patients are eligible for UKA. It cannot be done in very advanced arthritis where all compartments are damaged. It also cannot be done in patients who have damaged ACL or PCL ligaments. Even so a large number of arthritis  patients can benefit from this modern surgery. Your doctor is the best judge of whether you are eligible for UKA.
UKA is a bone, muscle and ligament preserving surgery done through a minimally invasive technique with advantages of fast recovery, less pain and better function. It is a spectacular gift of modern scientific research.

Unicondylar Knee Replacement

Total knee replacement is an excellent surgery. It has evolved over the decades to become one of the most successful procedures in all of medicine. Patients are cured of pain and disability. They regain their ability to walk normally, without a limp or support. They can resume living normal lives again. Without surgery, they are stuck in a rut of suffering and handicap with a lifelong dependency on kidney destroying medicines.

However, total knee replacement comes with a bag of its own problems. It is not without reason that patients fear the surgery. The foremost fear is that the surgery is a major surgical adventure.

Major surgery means more risk! The risk of an adverse event in the peri-operative period is always lurking round the corner.

Major surgery means more pain! Post operative pain is dreaded! Only recently have we truly succeeded in pain control with the use of ultrasound and nerve locator guided nerve blocks and LIA (local infiltration analgesia). 

Major surgery means more weakness! Patients routinely require a walker to walk for a week or two after surgery. 

Major surgery means a longer recovery! Patients take up to 3 months to return to normalcy and actually start experiencing the benefits of the surgery. 

What is a half knee (or partial knee) replacement? The knee is made of 3 different compartments. Two compartments are between the thigh and leg bone and the third compartment is between the knee cap and the thigh bone. In total knee replacement, we replace all three compartments and sacrifice two ligaments (out of 4) and both menisci (natural shock absorbers found in the knee). However, arthritis does not damage all compartments equally. Most of the times, it is only the medial or inner compartment that suffers the brunt of the destruction. In partial knee replacement, only this compartment is replaced with sacrifice of a single meniscus. Two compartments, all 4 ligaments and one meniscus is preserved. Many studies have shown this procedure to be as effective in relieving pain as total knee replacement. The survival of partial knee prosthesis is also as good as total knee prosthesis. 

By doing this selective procedure we gain many advantages. This surgery is done by a minimally invasive technique. It involves less cutting of skin, muscle, tissue and bone. Most of the knee is left untouched as it is healthy. Hence this is not a major surgery.

Risk of an adverse event is less!

Pain is very less! Lesser volume of trauma coupled with modern pain management makes post op pain negligible.  

Less muscle cutting means minimal weakness! Patients can stand and walk without a walker on the same day, a few hours after surgery. All this translates into a faster recovery. No longer do patients have to wait for 3 months to get back to normal.  

Partial knee replacement or unicondylar knee replacement is a natural evolution of a total knee replacement. It retains all the effectiveness of a total knee and brings with it significant advantages! I have pointed out the advantage of less risk and quicker pain-free recovery in this article.....but it doesn't stop here! Stay tuned for the next article.